Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #157 out of 500 highest-risk providers analyzed. This is a statistical prediction, not a determination of fraud.
ML model prediction — not an accusation of fraud
This provider's $379.1K in total Medicare payments ranks in the 93th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 110% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office visit, established patient, low complexity | 1.3K | $80.6K | $62.51 | 1.73x |
| 99214 | Office visit, established patient, moderate complexity | 1.2K | $72.5K | $62.52 | 1.94x |
| 99215 | Office visit, established patient, high complexity | 1.0K | $64.5K | $62.53 | 2.17x |
| 99395 | Preventive visit, 18-39 years | 902 | $56.4K | $62.53 | 1.85x |
| 99396 | Preventive visit, 40-64 years | 773 | $48.3K | $62.55 | 1.67x |
| 93000 | Electrocardiogram, complete | 644 | $40.3K | $62.56 | 2.09x |
| 71046 | Chest X-ray, 2 views | 515 | $32.2K | $62.59 | 2.22x |
| 80053 | Comprehensive metabolic panel | 387 | $24.2K | $62.47 | 2.07x |
| 85025 | Complete blood count with differential | 258 | $16.1K | $62.47 | 1.93x |
| 36415 | Venipuncture for blood draw | 129 | $8.1K | $62.47 | 1.95x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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